组织工程技术修复半月板损伤：从基础到临床的差距

doi:10.3969/j.issn.2095-4344.2016.11.020

摘要/Abstract

摘要：

文章快速阅读：

文题释义：

组织工程技术：是将生物材料工程与细胞移植结合，创建生物人工组织和器官来修复损伤组织和器官功能，应用生命科学与工程学的原理与技术，在正确认识哺乳动物的正常及病理两种状态下的组织结构与功能关系的基础上，研究、开发用于修复、维护、促进人体各种组织或器官损伤后的功能和形态的生物替代物的一门新兴学科和技术。

半月板损伤：半月板损伤是最常见的膝关节损伤，可引起关节疾病，半月板切除后膝关节发生退性行改变及生物力学变化，如何尽可能保留和修复半月板是半月板损伤的首要治疗原则。

背景：利用组织工程技术构建有功能的半月板为半月板损伤的修复提供了新思路。

目的：分析组织工程半月板修复中常用的种子细胞和支架材料研究进展。

方法：应用计算机检索CNKI和PubMed数据库1996至2015年有关半月板损伤修复和组织工程技术的应用方面的文献。中文关键词“半月板损伤、组织工程半月板、生物材料、干细胞”，英文关键词“meniscal repair，Meniscal Injury，tissue engineering ，tissue-engineered meniscus, biomaterials，stem cells ”。

结果与结论：组织工程半月板重建是一种较为可行的修复半月板损伤的方法，间充质干细胞具有多向分化潜能，是半月板组织工程理想的种子细胞。支架材料是半月板组织修复再生中最主要的因素之一，天然半月板支架材料起着重要的作用。半月板组织工程支架材料的选择与研制经历了由单一材料向复合材料研制的快速发展时期，复合材料可以弥补单一材料存在的诸多缺点和不足，为新型材料的研制开辟了新思路。组织工程技术能够形成几何形状的半月板组织，而在远期观察半月板组织的生物性能，尚缺乏足够的时间，有待于从基础到临床获得较为可靠的数据来证明组织工程学修复损伤半月板组织的作用。

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

ORCID: 0000-0002-3074-6722(侯立刚)

关键词: 组织构建, 组织工程, 半月板, 种子细胞, 支架, 生物材料

Abstract:

BACKGROUND: The use of tissue engineering technology to build a functional meniscus is a new idea for repair of meniscus injury.
OBJECTIVE: To analyze the research progress of seed cells and scaffold materials in tissue-engineered meniscus repair.
METHODS: A computer-based search of CNKI and PubMed was performed for articles related to tissue-engineered meniscus repair published from 1996 to 2015. The keywords were "meniscal repair, meniscal injury, tissue engineering, tissue-engineered meniscus, biomaterials, stem cells" in Chinese and English, respectively.
RESULTS AND CONCLUSION: Tissue-engineered meniscus reconstruction is a more viable method for repair of meniscus injury. Mesenchymal stem cells are pluripotent cells that are ideal seed cells for tissue-engineered meniscus reconstruction. Scaffolds are one of important factors for meniscus repair, and natural meniscal scaffolds play an important role. Selection and development of scaffold materials for meniscus tissue engineering have experienced a rapid development period from a single material to composite materials. Composite materials make up a lot of shortcomings and deficiencies that a single material has, and open up new ideas for developing new materials. Meniscal tissues with geometric shapes can be constructed using tissue engineering technology. However, the long-term observation of the biological properties of meniscal tissues is necessary, and from basic to clinic, there is still a lack of reliable data to prove the effect of tissue engineering technology in the meniscus repair.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

侯立刚，杨建义. 组织工程技术修复半月板损伤：从基础到临床的差距[J]. 中国组织工程研究, 2016, 20(11): 1651-1657.

Hou Li-gang, Yang Jian-yi. Tissue engineering technology for repair of meniscus injury: from basic to clinic[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(11): 1651-1657.

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引言

半月板由纤维软骨组成，是膝关节重要的构成部分，半月板在膝关节可以吸收振荡、传导膝关节的负荷、增加膝关节的稳定性并起到润滑关节和防止关节软骨发生退行性变的重要作用，对于保证膝关节的正常功能有重要意义(图1)。随着运动性损伤发生率的上升，半月板损伤病例在临床上也越来越多见，半月板缺失会引发膝关节退变加快，严重限制膝关节运动功能^[1-2]。由于半月板仅外缘部分有血液供应，中央部分游离缘没有血液供应，其营养主要来自关节内的滑液，故半月板损伤后，尤其是中央游离缘部分损伤后，半月板自行愈合的能力较差(图2)。半月板损伤后愈合的组织细胞主要来源于滑膜，关节液及纤维软骨内的成纤维细胞。

半月板损伤是临床中骨科常见病，既往半月板损伤后的治疗方案有半月板修补、半月板切除及半月板移植等。临床上较早同时也是较多应用的治疗方法为半月板切除，切除受损部分虽可解决症状，但切除后半月板缺失，功能丧失，患者易早期发生骨性关节炎^[3-5]。但越来越多的研究显示半月板切除会加速关节软骨的退行性改变，使骨关节炎的发生率上升，同时这种方法却能导致明显的功能缺陷，主要表现在膝关节屈伸肌肌力下降^[6-8]。

尽可能的保留、修复损伤的半月板已成为临床半月板损伤治疗的首要原则。组织工程技术是20世纪末期发展起来的新型学科，组织工程半月板重建有重要的研究和应用前景。随着大量新技术和新材料的应用，许多国内外学者试图通过组织工程方法来修复损伤的半月板甚至再造半月板，有望为无法保留半月板的患者提供治疗的新方法，为半月板修复提供一种新的治疗模式，并成为膝关节创伤治疗基础和临床研究的热点^[9-10]。三维支架、种子细胞是组织工程的两个重要因素。因此，有必要探讨这两种因素在半月板组织工程中的应用。

在组织工程的两个主要组分中，种子细胞是组织工程学研究中的基本要素和首要环节^[11]，此外支架材料是半月板组织工程研究的另一个重点，在所植入的体内不利环境中，为种子细胞提供一个临时性的庇护所，还能够促进种子细胞的黏附、增殖、分化、代谢，相关基因的表达以及新的功能性的细胞外基质的合成^[12-13]。采用不同的细胞来源、支架材料和生长因子来刺激和加快半月板组织的再生，但只有少数的方法

有实际转化为临床治疗方案的可行性，即使在这些方法中半月板长期的功能表现目前尚不清楚。更多的组织工程半月板的体外研究评估专注于新型材料的细胞生物学和生化特性，以分析和正常半月板的相似性。同时组织工程技术能够形成几何形状的半月板组织，而在远期观察半月板组织的生物性能，尚缺乏足够的时间，有待于从基础到临床获得较为可靠的数据来证明组织工程学修复损伤半月板组织的作用。

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程